Patient-specific humeral guide designs

ABSTRACT

A humeral cut guide system for a humeral head comprises: a bone-engagement member including a first patient-specific bone-engagement surface that is complementary and made to substantially mate and nest in only one position on a specific patient&#39;s humeral head; a registration member connected to the bone-engagement member including a second patient-specific bone engagement surface that is sized and made to substantially mate and nest in only one position with the specific patient&#39;s bicipital groove; a first protrusion extending from the registration member and having a first surgeon-engaging surface for manipulation by a surgeon; and a cut guide plate connected to and extending away from the registration member such that, upon the bone-engagement member mating and nesting with the specific patient&#39;s humeral head, the cut guide plate is spaced apart from the humeral head, wherein the cut guide plate defines an elongate slot.

This patent application is a continuation-in-part of Kehres et al, U.S.patent application Ser. No. 14/750,325, entitled “PATIENT-SPECIFICHUMERAL GUIDE DESIGNS,” filed on Jun. 25, 2015, the benefit of priorityof which is claimed hereby, and which is incorporated by referenceherein in its entirety.

FIELD

The present disclosure relates to humeral cut guide members.

BACKGROUND

This section provides background information related to the presentdisclosure which is not necessarily prior art.

During shoulder arthroplasty, the humeral bone may require resurfacingor resecting for receipt of a shoulder implant. Prior to surgery, it iscommon for the surgeon to take various images via X-ray, CT, ultrasound,MRI, or PET of the surgical area including the humeral bone. Based onthese images, the surgeon can determine the best course of action forresurfacing or resecting the humeral bone, as well as determine whetherthe primary procedure for shoulder repair is an anatomical or reversearthroplasty. During the surgery, however, it is not uncommon for thesurgeon to determine that the preselected courses of action are notsuitable for the patient. If the course of action changes duringsurgery, new instruments may be required to properly complete theresurfacing or resecting of the humeral bone before completing thearthroplasty procedure.

SUMMARY

This section provides a general summary of the disclosure, and is not acomprehensive disclosure of its full scope or all of its features.

The present disclosure provides a humeral cut guide system for a humeralhead comprises: a bone-engagement member including a firstpatient-specific bone-engagement surface that is complementary and madeto substantially mate and nest in only one position on a specificpatient's humeral head; a registration member connected to thebone-engagement member including a second patient-specific boneengagement surface that is sized and made to substantially mate and nestin only one position with the specific patient's bicipital groove; afirst protrusion extending from the registration member and having afirst surgeon-engaging surface for manipulation by a surgeon; and a cutguide plate connected to and extending away from the registration membersuch that, upon the bone-engagement member mating and nesting with thespecific patient's humeral head, the cut guide plate is spaced apartfrom the humeral head, wherein the cut guide plate defines an elongateslot.

The present disclosure also provides a humeral cut guide system for ahumeral head comprising: a bone-engagement member including a firstpatient-specific bone-engagement surface that is complementary and madeto substantially mate and nest in only one position on a specificpatient's humeral head; a registration member connected to thebone-engagement member including a second patient-specific boneengagement surface that is sized and made to substantially mate an nestin only one position with the specific patient's bicipital groove; anelongate member extending from the registration member; and a cut guideplate having a connection portion with a socket configured to receivethe elongate member such that a position of the cut guide plate relativeto the specific patient's humeral head is selectively adjustable alongthe elongate member in an infinite number of positions.

The present disclosure also provides a method of resecting orresurfacing a humeral head using a humeral cut guide comprising:positioning a bone-engagement member along a humeral head surface of ahumeral bone; positioning a registration member along a bicipital groovesurface of a humeral bone; squeezing the registration member and thebone-engagement member to ensure seating of the humeral cut guide;sliding a cut guide plate along an elongate member extending from thehumeral cut guide to engage the humeral head surface of the humeralbone; and resecting or resurfacing the humeral head using a cuttingdevice engaged with the cut guide plate.

Further areas of applicability will become apparent from the descriptionprovided herein. The description and specific examples in this summaryare intended for purposes of illustration only and are not intended tolimit the scope of the present disclosure.

DRAWINGS

The drawings described herein are for illustrative purposes only ofselected embodiments and not all possible implementations, and are notintended to limit the scope of the present disclosure.

FIG. 1 is an exploded view of a prior art implant for reverse shoulderarthroplasty;

FIG. 2 is an environmental view of the prior art implant of FIG. 1;

FIG. 3 is a perspective environmental view of a humeral cut guide memberaccording to a first embodiment of the present disclosure;

FIG. 4 is another perspective environmental view of the humeral cutguide member according to the first embodiment of the presentdisclosure;

FIG. 5 is another perspective environmental view of the humeral cutguide member according to the first embodiment of the presentdisclosure;

FIG. 6 is a perspective environmental view of a humeral cut guide memberaccording to a second embodiment of the present disclosure;

FIG. 7 is another perspective environmental view of the humeral cutguide member according to the second embodiment of the presentdisclosure;

FIG. 8 is another perspective environmental view of the humeral cutguide member according to the second embodiment of the presentdisclosure;

FIG. 9 is a perspective environmental view of a humeral cut guide memberaccording to a third embodiment of the present disclosure;

FIG. 10 is another perspective environmental view of the humeral cutguide member according to the third embodiment of the presentdisclosure;

FIG. 11 is a perspective environmental view of a humeral cut guidemember according to a fourth embodiment of the present disclosure;

FIG. 12 is another perspective environmental view of the humeral cutguide member according to the fourth embodiment of the presentdisclosure;

FIG. 13 is another perspective environmental view of a modified humeralcut guide member according to the fourth embodiment of the presentdisclosure;

FIG. 14 is a perspective environmental view of a humeral cut guidemember according to a fifth embodiment of the present disclosure;

FIG. 15 is another perspective environmental view of the humeral cutguide member according to the fifth embodiment of the presentdisclosure;

FIG. 16 is another perspective environmental view of the humeral cutguide member according to the fifth embodiment of the presentdisclosure;

FIG. 17 is another perspective environmental view of the humeral cutguide member according to the fifth embodiment of the presentdisclosure;

FIG. 18 is another perspective environmental view of the humeral cutguide member according to the fifth embodiment of the presentdisclosure;

FIG. 19 is another perspective environmental view of the humeral cutguide member according to the fifth embodiment of the presentdisclosure; and

FIG. 20 is a perspective view of a modified humeral cut guide memberaccording to the fifth embodiment of the present disclosure.

FIG. 21A shows an anterior perspective view of a humeral cut guidesystem attached to a humeral bone and having a cut guide plateconfigured to smoothly slide on a cut guide member.

FIG. 21B shows a lateral perspective view of the humeral cut guidesystem of FIG. 21A having protrusions to facilitate attachment of thesystem to the humeral bone by a surgeon.

FIG. 21C shows another perspective view of the humeral cut guide systemof FIG. 21A attached to the humeral bone to show the cut guide memberand the protrusions.

Corresponding reference numerals indicate corresponding parts throughoutthe several views of the drawings.

DETAILED DESCRIPTION

Example embodiments will now be described more fully with reference tothe accompanying drawings.

The present disclosure generally provide patient-specific surgicalinstruments that include, for example, alignment guides, drill guides,and other tools for use in shoulder joint replacement, shoulderresurfacing procedures and other procedures related to the shoulderjoint or the various bones of the shoulder joint, including the humeralhead. The present disclosure can be applied to anatomic shoulderreplacement and reverse shoulder replacement. The patient-specificinstruments can be used either with conventional implant components orwith patient-specific implant components and/or bone grafts that areprepared using computer-assisted image methods according to the presentdisclosure. Computer modeling for obtaining three-dimensional images ofthe patient's anatomy using medical scans of the patient's anatomy (suchas MRI, CT, ultrasound, X-rays, PET, etc.), the patient-specificprosthesis components and the patient-specific guides, templates andother instruments, can be prepared using various commercially availableCAD programs and/or software available, for example, by Object ResearchSystems or ORS, Montreal, Canada.

The patient-specific instruments and any associated patient-specificimplants and bone grafts can be generally designed and manufacturedbased on computer modeling of the patient's 3-D anatomic image generatedfrom medical image scans including, for example, X-rays, MRI, CT, PET,ultrasound or other medical scans. The patient-specific instruments canhave a three-dimensional engagement surface that is complementary andmade to substantially mate and match in only one position (i.e., as asubstantially negative or mirror or inverse surface) with athree-dimensional bone surface with or without associated soft tissues,which is reconstructed as a 3-D image via the aforementioned CAD orsoftware. Very small irregularities need not be incorporated in thethree-dimensional engagement surface. The patient-specific instrumentscan include custom-made guiding formations, such as, for example,guiding bores or cannulated guiding posts or cannulated guidingextensions or receptacles that can be used for supporting or guidingother instruments, such as drill guides, reamers, cutters, cuttingguides and cutting blocks or for inserting guiding pins, K-wire, orother fasteners according to a surgeon-approved pre-operative plan.

In various embodiments, the patient-specific instruments of the presentdisclosure can also include one or more patient-specific guide membersfor receiving and guiding a tool, such as a drill or saw atcorresponding patient-specific insertion points and orientationsrelative to a selected anatomic or reverse axis for the specificpatient. The patient-specific instruments can include guiding ororientation formations and features for guiding the implantation ofpatient-specific or off-the-shelf implants associated with the surgicalprocedure. The geometry, shape and orientation of the various featuresof the patient-specific instruments, as well as various patient-specificimplants and bone grafts, if used, can be determined during thepre-operative planning stage of the procedure in connection with thecomputer-assisted modeling of the patient's anatomy. During thepre-operative planning stage, patient-specific instruments, custom,semi-custom or non-custom implants and other non-custom tools, can beselected and the patient-specific components can be manufactured for aspecific-patient with input from a surgeon or other professionalassociated with the surgical procedure.

In the following discussion, the terms “patient-specific”, “custom-made”or “customized” are defined to apply to components, including tools,implants, portions or combinations thereof, which include certaingeometric features, including surfaces, curves, or other lines, andwhich are made to closely conform substantially as mirror-images ornegatives or complementary surfaces of corresponding geometric featuresor anatomic landmarks of a patient's anatomy obtained or gathered duringa pre-operative planning stage based on 3-D computer images of thecorresponding anatomy reconstructed from image scans of the patient bycomputer imaging methods. Further, patient-specific guiding features,such as, guiding apertures, guiding slots, guiding members or otherholes or openings that are included in alignment guides, drill guides,cutting guides, rasps or other instruments or in implants are defined asfeatures that are made to have positions, orientations, dimensions,shapes and/or define cutting planes and axes specific to the particularpatient's anatomy including various anatomic or mechanical axes based onthe computer-assisted pre-operative plan associated with the patient.

The patient-specific guide members can be configured to mate inalignment with natural anatomic landmarks by orienting and placing thecorresponding alignment guide intra-operatively on top of the bone tomate with corresponding landmarks. The anatomic landmarks function aspassive fiducial identifiers or fiducial markers for positioning of thevarious alignment guide members, drill guides or other patient-specificinstruments.

The various patient-specific alignment guide members can be made of anybiocompatible material, including, polymer, ceramic, metal orcombinations thereof. The patient-specific alignment guide members canbe disposable and can be combined or used with reusable andnon-patient-specific cutting and guiding components.

More specifically, the present disclosure provides various embodimentsof patient-specific humeral cut guide members for anatomic and reversearthroplasty. The humeral cut guides of the present disclosure can havepatient-specific engagement surfaces that reference various portions ofthe shoulder joint and include tubular drill guides, guiding bores orsleeves or other guiding formations that can accurately position guidepins for later humeral preparation and implantation procedures and foralignment purposes, including implant position control, implant versioncontrol, implant inclination control for both anatomic and reversearthroplasty.

In the following, when a portion of a humeral guide member is describedas “referencing” a portion of the anatomy, it will be understood thatthe referencing portion of the humeral guide member is apatient-specific portion that mirrors or is a negative of thecorresponding referenced anatomic portion.

In some embodiments the humeral guide member can have built-in holes,openings or windows that allow the surgeon to mark the humeral bone or amodel of the humeral bone with a marking pen, burr, scalpel, or anyother device that can create markings to be used as landmarks on or inthe humeral bone or humeral model. These landmarks can be used for theorientation of a secondary guide.

Referring to FIGS. 1 and 2, a prior art reverse shoulder implant 10 isillustrated. The reverse shoulder implant 10 includes a humeral stem 12,a humeral tray 14, a humeral bearing 16, a glenosphere 18 and abaseplate 20 having a plate portion 22 and a central boss 24. Thehumeral stem 12 is implanted in the humeral bone 26 and has a proximalend 28 coupled via a Morse taper connection to a male taper 30 extendingfrom a plate 32 of the humeral tray 14. The glenosphere 18 can bemodular and include a head 34 articulating with the bearing 16 and anoffset double-taper component 36. The double-taper component 36 has afirst tapered portion 38 coupled to a corresponding tapered opening 40of the head 34 and a second tapered portion 42 coupled to the centralboss 24 of the glenoid baseplate 20. A central screw 44 passes throughthe baseplate 20 into the glenoid face 46 of the patient's scapula.Peripheral screws 48 are used to lock the baseplate 20 in the glenoidface 46.

As best illustrated in FIG. 2, humeral bone 26 includes a planar surface50 for abutment with plate 32 of humeral tray 14. To provide planarsurface 50, humeral bone 26 is cut using a tool such as a bone saw (notshown). To properly orient the saw at the correct angle relative tohumeral bone 26, the present disclosure provides a humeral cut guidesystem 52.

Referring to FIGS. 3-5, an exemplary humeral cut guide system 52according to an aspect of the present disclosure is illustrated. Humeralcut guide system 52 includes a patient-specific humeral cut guide member54. Humeral cut guide member 54 is configured to be patient-specificsuch that humeral cut guide member 54 mates with and nests in only oneposition on humeral bone 26. In this regard, humeral cut guide member 54includes a bone-engagement member 58 having a bone-engagement surface 60that is complementary and made to substantially mate and nest in onlyone position (i.e., as a substantially negative or mirror or inversesurface) with a three-dimensional bone surface 61 of humeral bone 26with or without associated soft tissues, which is reconstructed as a 3-Dimage via the aforementioned CAD or software.

As best illustrated in FIG. 3, bone-engagement member 58 andbone-engagement surface 60 are each pie-shaped and specifically designedto mate and nest on a proximal portion of the lesser tuberosity 62 ofhumeral bone 26. An opposing surface 64 of bone-engagement member 58defines a protrusion 66 that provides a curved contact surface 68 thatallows humeral cut guide member 54 to be manipulated by the surgeon intocorrect alignment on the humeral bone 26. In other words, the surgeonmay place a finger-tip upon contact surface 68, which allows the surgeonto more easily orient the humeral cut guide member 54 in a manner thatbone-engagement surface 60 properly aligns with bone surface 62 ofhumeral bone 26.

A curved connecting member 70 extends away from bone-engagement member58 and connects bone-engagement member 58 with a patient-specific pinguide aperture 72. Pin guide aperture 72 is aligned per the specificpatient and allows for passage of a drill, Steinmann pin, or guidewire(not shown), that allows humeral bone 26 to be reamed at the appropriatelocation for any desired resurfacing of humeral bone 26. As illustrated,connecting member 70 is spaced apart from humeral bone 26. It should beunderstood, however, that connecting member 70 may be designed to abuthumeral bone 26. In such a case, connecting member 70 may also include apatient-specific mating surface that is designed to mate and nest withhumeral bone 26 in a single position.

A registration member 74 extends away from bone-engagement member 58 ina direction different from that of connecting member 70. Similar tobone-engagement member 58, registration member 74 includes abone-engagement surface 76 that is designed to mate and nest withhumeral bone 26 in a single position. Specifically, bone-engagementsurface 76 of registration member 74 is patient-specifically sized andshaped to mate with the bicipital groove 78 (see, e.g., FIG. 6) ofhumeral bone 26. Thus, registration member 74 is an elongated tab-shapedmember having a proximal end 80 unitary or connected to bone-engagementmember 58 and a distal end 82 located away from bone-engagement member58. With the pie-shaped bone-engagement member 58 and elongatedregistration member 74, humeral cut guide member 54 is configured tonest with humeral head 26 in a single position with as little materialas possible. In this manner, a majority (i.e., at least 75%) of humeralhead 26 is exposed during the surgical procedure to allow the surgeongreater visual access to the humeral head 26.

Humeral cut guide member 54 includes a cut guide plate 84 including anelongated slot 86. As best shown in FIG. 5, cut guide plate 84 isunitary or connected to bone-engagement member 58 with acylindrically-shaped member 88 that extends outward from bone-engagementmember 58 in a direction different from each of connecting member 70 andregistration member 74. Cylindrically-shaped member 88 extends outwardfrom bone-engagement member 88 to an extent that cut guide plate 84 willbe spaced apart from humeral head 26. By spacing cut guide plate 84 awayfrom humeral head 26, the unnecessary removal of soft-tissue (e.g.,muscle, cartilage, etc.) from humeral head 26 is prevented, whichassists in the patient's recovery after the arthroplasty. It should beunderstood, however, that cut guide plate 84 may be configured to abuthumeral bone 26 during pre-operative design of humeral cut guide system52, if desired.

Cut guide plate 84 includes an upper surface 90 and a lower surface 92,with elongated slot 86 positioned therebetween. Upper surface 90includes a reinforcing rib 94 extending along an entire length of uppersurface 90. Lower surface 92 defines a pair of tube-shaped apertures 96.Tube-shaped apertures are configured to receive a drill (not shown) fordrilling humeral bone 26. After drilling of the humeral bone 26, a pairof pins (not shown) such as Steinmann pins or K-wires may be implantedin humeral bone 26, which may be used to assist in securing humeral cutguide member 54 to humeral bone 26. Alternatively, the pair of pins maybe used to support a secondary cut guide (not shown) that is configuredto assist in resecting or resurfacing of the humeral bone 26 at adifferent angle in comparison to the angle defined by humeral cut guidemember 54. An exemplary secondary cut guide may be found in U.S. Ser.No. 14/265,577 assigned to Biomet Manufacturing, LLC. In this regard,after implantation of the pins, the humeral cut guide member 54 may beremoved from humeral bone 26 with the pins remaining in place. Thesecondary cut guide may then be mated with the pins relative to thehumeral bone 26.

Although not required, lower surface 92 may extend outward relative toupper surface 90 such that a shelf or platform 98 is formed. Platform 98allows for a greater amount of surface area for the tool blade (notshown) to lie upon during resurfacing or resecting of the humeral bone26. In this manner, the tool blade is substantially prevented from beingimproperly angled during the resurfacing or resecting of the humeralbone 26 to form planar surface 50. It should be understood that ifplatform 98 is used, upper surface 90 and reinforcing rib 94 may beomitted. In such a configuration, the tool blade would simply lie uponplatform 98 during resurfacing or resecting of the humeral bone 26.

Now referring to FIGS. 6-8, another exemplary humeral cut guide system200 is illustrated. Humeral cut guide system 200 includes a humeral cutguide member 202. Humeral cut guide member 202 is configured to bepatient-specific such that humeral cut guide member 202 mates with andnests in only one position on humeral bone 26. In this regard, humeralcut guide member 202 includes a bone-engagement member 204 having abone-engagement surface 206 that is complementary and made tosubstantially mate and nest in only one position (i.e., as asubstantially negative or mirror or inverse surface) with athree-dimensional bone surface 61 of humeral bone 26 with or withoutassociated soft tissues, which is reconstructed as a 3-D image via theaforementioned CAD or software.

As best illustrated in FIG. 6, bone-engagement member 204 andbone-engagement surface 206 are specifically designed to mate and neston a distal portion of the lesser tuberosity 62 of humeral bone 26. Inthis regard, a bone-engagement member 204 is a curved member includingan upper edge 208 located adjacent the distal portion of the lesstuberosity 62, an opposing lower edge 210, and side edges 212.

As best illustrated in, for example, FIGS. 7 and 8, bone-engagementmember 204 wraps about a portion of humeral bone 26 in the medialdirection from the bicipital groove 78. A registration member 214 islocated at a first end 216 of bone-engagement member 204. Registrationmember 214 extends away from upper edge 208 of bone-engagement member204 in a direction substantially orthogonal to bone-engagement member204. Similar to bone-engagement member 204, registration member 214includes a bone-engagement surface 218 that is designed to mate and nestwith humeral bone 26 in a single position.

Specifically, bone-engagement surface 218 of registration member 214 ispatient-specifically sized and shaped to mate with the bicipital groove78 of humeral bone 26. Thus, registration member 214 is an elongatedtab-shaped member having a proximal end 220 unitary or connected tobone-engagement member 214 and a distal end 222 located away from upperedge 208. With the bone-engagement member 204 and elongated registrationmember 214, humeral cut guide member 204 is configured to nest withhumeral head 26 at a position that allows for nearly an entirety (i.e.,at least 90%) of humeral head 26 to be exposed during the surgicalprocedure to allow the surgeon greater visual access to the humeral head26.

Humeral cut guide member 202 includes a cut guide plate 224 including anelongated slot 226. As best shown in FIG. 8, cut guide plate 224 isunitary or connected to bone-engagement member 214 at a second end 228of bone-engagement member 214. Specifically, cut guide plate 224includes an upper surface 230 and a lower surface 232, with elongatedslot 226 positioned therebetween. Lower surface 232 defines a firsttube-shaped aperture 234 that, in addition to being configured toreceive a drill (not shown) for drilling humeral bone 26, connects cutguide plate 224 to second end 228. A second tube-shaped aperture 236 islocated at distal end 222 of registration member 214, and is connectedto cut guide plate 224 via a connecting arm 238.

Similar to the above-described embodiment illustrated in FIGS. 3-5,after drilling of the humeral bone 26, a pair of pins (not shown) suchas Steinmann pins or K-wires may be implanted in humeral bone 26 usingfirst and second tube-shaped apertures 234 and 236, which may be used toassist in securing humeral cut guide member 202 to humeral bone 26.Alternatively and as also described in the exemplary embodimentillustrated in FIGS. 3-5, the pair of pins may be used to support asecondary cut guide (not shown) that is configured to assist inresecting or resurfacing of the humeral bone 26 at a different angle incomparison to the angle defined by humeral cut guide member 202.

Although cut guide plate 224 is illustrated as being spaced apart fromhumeral head 26, it should be understood that cut guide plate 224 may beconfigured to abut humeral bone 26 during pre-operative design ofhumeral cut guide system 52, if desired. By spacing cut guide plate 224away from humeral head 26, however, the unnecessary removal ofsoft-tissue (e.g., muscle, cartilage, etc.) from humeral head 26 isprevented, which assists in the patient's recovery after thearthroplasty. Further, although not required, lower surface 232 mayextend outward relative to upper surface 230 such that a shelf orplatform 98 (see FIG. 5, described above) is formed. Platform 98 allowsfor a greater amount of surface area for the tool blade (not shown) tolie upon during resurfacing or resecting of the humeral bone 26. In thismanner, the tool blade is substantially prevented from being improperlyangled during the resurfacing or resecting of the humeral bone 26 toform planar surface 50.

Still further, it should be understood that humeral cut guide system 200may include the curved connecting member 70, which may extend away fromupper surface 230 of cut guide plate 224 and connect cut guide plate 224member with a patient-specific pin guide aperture 72 (see, e.g., FIG.3). The pin guide aperture 72 may be aligned per the specific patientand allows for passage of a drill, Steinmann pin, or guidewire (notshown), that allows humeral bone 26 to be reamed at the appropriatelocation for any desired resurfacing of humeral bone 26.

Now referring to FIGS. 9 and 10, another exemplary humeral cut guidesystem 300 is illustrated. Humeral cut guide system 300 includes ahumeral cut guide member 302. Humeral cut guide member 302 is configuredto be patient-specific such that humeral cut guide member 302 mates withand nests in only one position on humeral bone 26. In this regard,humeral cut guide member 302 includes a bone-engagement member 304having a bone-engagement surface 306 that is complementary and made tosubstantially mate and nest in only one position (i.e., as asubstantially negative or mirror or inverse surface) with athree-dimensional bone surface 62 of humeral bone 26 with or withoutassociated soft tissues, which is reconstructed as a 3-D image via theaforementioned CAD or software.

As best illustrated in FIG. 9, bone-engagement member 304 andbone-engagement surface 306 are specifically designed to mate and nestmedially off of the proximal humeral bone 26. In this regard, abone-engagement member 304 is a curved member including an upper edge308 located adjacent the distal portion of the greater tuberosity 63, anopposing lower edge 310, and side edges 312. Bone-engagement member 304wraps about a portion of humeral bone 26 laterally from the distalportion of the greater tuberosity 63 in a direction toward bicipitalgroove 78, and includes a first end 314 and a second end 316. Extendingfrom second end 316 is a cut guide plate 318 including an elongated slot320.

As best shown in FIG. 9, cut guide plate 318 is unitary or connected tobone-engagement member 304 at a second end 316. Cut guide plate 318includes an upper surface 322 and a lower surface 324, with elongatedslot 320 positioned therebetween. Lower surface 322 defines a firsttube-shaped aperture 326 that is configured to receive a drill (notshown) for drilling humeral bone 26, and after drilling of the humeralbone 26, is configured to receive a pin (not shown) that is operable tosecure humeral cut guide member 302 to the humeral bone 26. A secondtube-shaped aperture 328 may also be formed at second end 316 that isconfigured to receive a drill (not shown) for drilling humeral bone 26,and after drilling of the humeral bone 26, is configured to receive apin (not shown) that is operable to secure humeral cut guide member 302to the humeral bone 26. The above-noted configuration allows for nearlyan entirety (i.e., at least 90%) of humeral head 26 to be exposed duringthe surgical procedure to allow the surgeon greater visual access to thehumeral head 26.

Although not illustrated, it should be understood that humeral cut guidesystem 300 may include the curved connecting member 70, which may extendaway from upper surface 322 of cut guide plate 318 and connect cut guideplate 318 with a patient-specific pin guide aperture 72 (see, e.g., FIG.3). The pin guide aperture 72 may be aligned per the specific patientand allows for passage of a drill, Steinmann pin, or guidewire (notshown), that allows humeral bone 26 to be reamed at the appropriatelocation for any desired resurfacing of humeral bone 26. Alternatively,the curved connecting member 70 and pin guide aperture 72 may extendfrom upper edge 308 at a location positioned proximate first end 314.

In addition, although cut guide plate 318 is illustrated as being spacedapart from humeral head 26, it should be understood that cut guide plate318 may be configured to abut humeral bone 26 during pre-operativedesign of humeral cut guide system 300, if desired. By spacing cut guideplate 318 away from humeral head 26, the unnecessary removal ofsoft-tissue (e.g., muscle, cartilage, etc.) from humeral head 26 isprevented, which assists in the patient's recovery after thearthroplasty. Further, although not required, lower surface 322 mayextend outward relative to upper surface 320 such that a shelf orplatform 98 (see FIG. 5, described above) is formed. Platform 98 allowsfor a greater amount of surface area for the tool blade (not shown) tolie upon during resurfacing or resecting of the humeral bone 26. In thismanner, the tool blade is substantially prevented from being improperlyangled during the resurfacing or resecting of the humeral bone 26 toform planar surface 50.

Now referring to FIGS. 11 and 12, another exemplary humeral cut guidesystem 400 according to an aspect of the present disclosure isillustrated. Humeral cut guide system 400 includes a ring-shapedpatient-specific humeral cut guide member 402 that encircles the greatertuberosity 63 of the humeral head 26. Humeral cut guide member 402 ispatient-specific and includes a bone-engagement surface 404 that iscomplementary and made to substantially mate and nest in only oneposition (i.e., as a substantially negative or mirror or inversesurface) with a three-dimensional bone surface 61 of humeral bone 26with or without associated soft tissues, which is reconstructed as a 3-Dimage via the aforementioned CAD or software. Although humeral cut guidemember 402 is illustrated as being ring-shaped, it should be understoodthat humeral cut guide member 402 may be horseshoe-shaped (FIG. 13), ifdesired.

Humeral cut guide member 402, in addition to bone-engagement surface404, includes an upper surface 406 and a lower surface 408. Extendingradially inward and over humeral head 26 toward a center of humeral cutguide member 402 are a plurality of pie-shaped ribs 410. Ribs 410 mayinclude a wider proximal portion 412 unitary with humeral cut guidemember 402 and a narrower distal portion 414. Alternatively, ribs 410may include the same width along the entire length thereof. Althoughonly three ribs 410 are illustrated in FIGS. 11 and 12, it should beunderstood that a greater or lesser number of ribs 410 may be used,without departing from the scope of the present disclosure. Regardless,spaces 411 between ribs 410 allow for easier viewing of humeral head 26by the surgeon during the surgical procedure. In this regard, humeralcut guide member 402 is designed such that at least 50% of the humeralhead 26 is exposed or visible when humeral cut guide member 402 is matedthereto.

The distal portions 414 terminate at a patient specific pin guideaperture 416. Pin guide aperture 416 may be aligned per the specificpatient and allows for passage of a drill, Steinmann pin, or guidewire(not shown), that allows humeral bone 26 to be reamed at the appropriatelocation for any desired resurfacing of humeral bone 26. Pin guideaperture 416 includes an exterior surface 418 and a bone-engagementsurface 420. Bone-engagement surface 420 may be patient specificallydesigned pre-operatively. Further, although ribs 410 are illustrated asbeing spaced apart from humeral head 26, it should be understood thatribs 410 may abut humeral head 26 with a patient specificbone-engagement surface as well.

A cut guide plate 422 is unitary or connected to humeral cut guidemember 402 by a pair of connection members 424 such that cut guide plate422 is spaced apart from humeral bone 26. By spacing cut guide plate 422away from humeral head 26, the unnecessary removal of soft-tissue (e.g.,muscle, cartilage, etc.) from humeral head 26 is prevented, whichassists in the patient's recovery after the arthroplasty. Cut guideplate 422 includes an upper surface 426 and a lower surface 428, with anelongated slot 430 positioned therebetween. Lower surface 428 defines apair of tube-shaped apertures 432 that are configured to receive a drill(not shown) for drilling humeral bone 26. After drilling of the humeralbone 26, the tube-shaped apertures 432 are configured to receive a pin(not shown) that is operable to secure humeral cut guide member 402 tothe humeral bone 26. The above-noted configuration allows for a majorityof humeral head 26 to be exposed during the surgical procedure to allowthe surgeon greater visual access to the humeral head 26.

Although cut guide plate 422 is illustrated as being spaced apart fromhumeral head 26, which is desirable to preserve soft tissue as notedabove, it should be understood that cut guide plate 422 may beconfigured abut humeral bone 26 during pre-operative design of humeralcut guide system 400, if desired. Further, although not required, lowersurface 428 may extend outward relative to upper surface 426 such that ashelf or platform 98 is formed. Platform 98 allows for a greater amountof surface area for the tool blade (not shown) to lie upon duringresurfacing or resecting of the humeral bone 26. In this manner, thetool blade is substantially prevented from being improperly angledduring the resurfacing or resecting of the humeral bone 26 to formplanar surface 50.

Moreover, although not illustrated in FIGS. 11 and 12, it should beunderstood that humeral cut guide member 402 may include a registrationmember (see, e.g., the registration member 74 in FIG. 3) similar tothose described above. That is, humeral cut guide member 402 may includeregistration member (not shown) that extends away from humeral cut guidemember 402 in a direction different from that ribs 410 including abone-engagement surface 76 that is designed to mate and nest with thebicipital groove 78 of humeral bone 26.

Now referring to FIGS. 14-20, another exemplary humeral cut guide system500 according to an aspect of the present disclosure is illustrated.Humeral cut guide system 500 includes a patient-specific humeral cutguide member 502. Humeral cut guide member 502 is configured to bepatient-specific such that humeral cut guide member 502 mates with andnests in only one position on humeral bone 26. In this regard, humeralcut guide member 502 includes a bone-engagement member 504 having abone-engagement surface 506 that is complementary and made tosubstantially mate and nest in only one position (i.e., as asubstantially negative or mirror or inverse surface) with athree-dimensional bone surface 62 of humeral bone 26 with or withoutassociated soft tissues, which is reconstructed as a 3-D image via theaforementioned CAD or software.

As best illustrated in FIG. 14, bone-engagement member 504 includes anelongated primary member 508 extending in a first direction (i.e., adirection parallel with a coronal plane of the body) over humeral head26, including a pin guide aperture 510. Pin guide aperture 510 isaligned per the specific patient and allows for passage of a drill,Steinmann pin, or guide wire (not shown), that allows humeral bone 26 tobe reamed at the appropriate location for any desired resurfacing ofhumeral bone 26. Bone-engagement member 504 also includes a pair ofsecondary members 512 extending substantially orthogonal to primarymember 508. Secondary members 512 define a portion of bone-engagementsurface 506, and assist in mating and nesting humeral cut guide member502 in only one position on humeral bone 26 with or without associatedsoft tissues.

Bone-engagement member 504 also includes a registration member 514 thatis patient-specifically sized and shaped to mate with the bicipitalgroove 78 of humeral bone 26. Thus, registration member 514 is anelongated tab-shaped member having a proximal end 516 unitary orconnected to bone-engagement member 504 and a distal end 518 locatedaway from bone-engagement member 504. With the primary member 508,secondary members 512, and elongated registration member 514, humeralcut guide member 504 is configured to nest with humeral head 26 in asingle position with as little material as possible. In this manner, amajority of humeral head 26 is exposed during the surgical procedure toallow the surgeon greater visual access to the humeral head 26. In thisregard, humeral cut guide member 502 is designed such that at least60%/o of the humeral head 26 is exposed or visible when humeral cutguide member 402 is mated thereto.

Registration member 514 may also define a protrusion 520 that provides acurved contact surface 522 that allows humeral cut guide member 504 tobe manipulated by the surgeon into correct alignment on the humeral bone26. In other words, the surgeon may place a finger-tip upon contactsurface 522, which allows the surgeon to more easily orient the humeralcut guide member 504 in a manner that bone-engagement surface 506properly aligns with bone surface 62 of humeral bone 26.

Humeral cut guide member 502 includes a cut guide plate 524 including anelongated slot 526. As best shown in FIGS. 14, 15, 18, and 19, cut guideplate 524 is connected to bone-engagement member 504 with a tube-shapedmember 528 that extends outward from registration member 514 such thatcut guide plate 524 may be spaced apart from humeral head 26. By spacingcut guide plate 524 away from humeral head 26, the unnecessary removalof soft-tissue (e.g., muscle, cartilage, etc.) from humeral head 26 isprevented, which assists in the patient's recovery after thearthroplasty. Although tube-shaped member 528 extends outward frombone-engagement member 504 to an extent that cut guide plate 524 will bespaced apart from humeral head 26, it should be understood, however,that the location of cut guide plate 524 may be adjusted alongtube-shaped member 528 such that cut guide plate 524 may be moved closerto humeral bone 26, if desired.

More specifically, cut guide plate 524 includes a connection portion 530at an end 532 thereof that is configured to mate with tube-shaped member528. Further, connection portion 530 may include a mating aperture 534that is designed to mate with one of a plurality of protrusions 536formed along a surface 539 of tube-shaped member 528. In this regard,connection portion 530 may be urged along tube-shaped member 528 toadjust the position of cut guide plate 524 relative to humeral head 26.As connection portion 530 is urged along tube-shaped member 528, themating aperture 534 will mate with protrusions 536 such that connectionportion 530 may be positioned at the selected protrusion 536. Connectionportion 530 may then only be moved when a force sufficient to disengagethe mating aperture 534 from the selected protrusion 536 is provided tothe connection portion 530. In this manner, the position of cut guideplate 524 may be selectively adjusted based on the preferences of thesurgeon during the shoulder arthroplasty. It should be understood thatalthough cut guide plate 524 has been described above as being movablealong tube-shaped member 528, the present disclosure contemplatesconfigurations where cut guide plate 524 is immovably fixed totube-shaped member 528.

As best shown in FIG. 16, cut guide plate 524 includes an upper member538 spaced apart from a lower member 540, with elongated slot 526defined by a gap 542 between upper member 538 and lower member 540.Lower member 540 defines an elongated aperture 544 that is configured toreceive a drill (not shown) for drilling humeral bone 26. After drillingof the humeral bone 26, a pin (not shown) such as a Steinmann pin orK-wire may be implanted in humeral bone 26, which may be used to assistin positioning humeral cut guide member 502 relative to humeral bone 26.In the illustrated embodiment, elongated aperture 544 travels parallelto tube-shaped member 528 to allow cut guide plate 524 to move alongtube-shaped member 528 without interference from the pin (not shown). Ifcut guide plate 524 is immovable fixed to tube-shaped member 528,however, it will be appreciated that elongated aperture 544 may extendin a non-parallel manner relative to tube-shaped member 528 to assist insecuring cut guide member 502 to humeral bone 526.

Although only a single elongated aperture 544 is illustrated in thefigures, it should be understood that a pair of elongated apertures 544may be used to allow for a pair of pins to be used to support asecondary cut guide (not shown) that is configured to assist inresecting or resurfacing of the humeral bone 26 at a different angle incomparison to the angle defined by humeral cut guide member 502. Anexemplary secondary cut guide may be found in U.S. Ser. No. 14/265,577assigned to Biomet Manufacturing, LLC. In this regard, afterimplantation of the pins, the humeral cut guide member 502 may beremoved from humeral bone 26 with the pins remaining in place. Thesecondary cut guide may then be mated with the pins relative to thehumeral bone 26.

Although not required, lower member 540 may define a surface 546 thatextends outward relative to upper member 538 such that a shelf orplatform 548 is formed. Platform 548 allows for a greater amount ofsurface area for the tool blade (not shown) to lie upon duringresurfacing or resecting of the humeral bone 26. In this manner, thetool blade is substantially prevented from being improperly angledduring the resurfacing or resecting of the humeral bone 26 to formplanar surface 50.

Lastly, as best shown in FIG. 20, a support bar 550 may fix upper member538 to lower member 540. Support bar 550 is formed at an opposite end552 of cut guide plate 524 relative to tube-shaped member 528, andassist in maintaining the proper gap 542 between upper member 538 andlower member 540. Notwithstanding, it should be understood that supportbar 550 is removable during surgery by cutting support bar 550 with thesaw or blade for resecting or resurfacing humeral bone 26, as desired bythe surgeon. It should be understood that although tube-shaped member528 is illustrated as fixing cut guide plate 524 in one positionrelative to humeral head 26, tube-shaped member 528 may be adjustable asillustrated in FIGS. 14-19.

FIG. 21A shows an anterior perspective view of humeral cut guide system600 attached to humeral bone 26 and having cut guide plate 624configured to smoothly slide on cut guide member 602. FIG. 21B shows alateral perspective view of humeral cut guide system 600 attached tohumeral bone 26 and having protrusions 620A and 620B to facilitatemanipulation of cut guide system 600 by a surgeon. FIG. 21C showsanother perspective view of humeral cut guide system 600 attached tohumeral bone 26 to show cut guide member 602, cut guide plate 624 andprotrusions 620A and 620B.

Humeral cut guide system 600 includes patient-specific humeral cut guidemember 602 and cut guide plate 624. Cut guide member 602 includesbone-engagement member 604, which is defined by primary member 608 thatincludes pin guide 610 and supports 612 and 613. Cut guide member 602also includes registration member 614, which includes first registrationportion 616 and second registration portion 618. Cut guide member 602also includes first protrusion 620A connected to first registrationportion 616, and second protrusion 620B connected between secondregistration portion 618 and primary member 608. First protrusion 620Aincludes support 622.

Cut guide plate 624 is connected to cut guide member 602 via elongatemember 628. Cut guide plate 624 includes connection portion 630, socket634, slot 626 defined by gap 642, elongate members 638 and 640,apertures 644A and 644B and support bar 650.

Bone-engagement member 604 includes first patient-specificbone-engagement surface 660. Registration member 614 includes secondpatient-specific bone-engagement surface 662 and third patient-specificbone-engagement surface 664. Support 622 includes fifth patient-specificbone-engagement surface 666.

Now referring to FIGS. 21A-21C, humeral cut guide system 600 illustratesanother example according to an aspect of the present disclosure havingsmooth elongate member 628 and protrusions 620A and 620B. Humeral cutguide system 600 includes patient-specific humeral cut guide member 602.Humeral cut guide member 602 is configured to be patient-specific suchthat humeral cut guide member 602 mates with and nests in only oneposition on humeral bone 26. In this regard, humeral cut guide member602 includes bone-engagement member 604 having bone-engagement surface660 that is complementary and made to substantially mate and nest inonly one position (i.e., as a substantially negative or mirror orinverse surface) with a three-dimensional bone surface of humeral bone26 with or without associated soft tissues, which is reconstructed as a3-D image via the aforementioned CAD or software. Humeral cut guidemember 602 also includes registration member 614 having surfaces 662 and664 that are patient-specifically sized and shaped to mate withbicipital groove 78 (FIG. 6) of humeral bone 26.

Registration member 614 is an elongated tab-shaped member havingproximal end 618 unitary with or connected to bone-engagement member604, and distal end 616 located away from bone-engagement member 604.With primary member 608, supports 612 and 613, and elongatedregistration member 614, humeral cut guide member 602 is configured tonest with humeral head 26 in a single position with as little materialas possible. In this manner, a majority of humeral head 26 is exposedduring the surgical procedure to allow the surgeon greater visual accessto the humeral bone 26. Furthermore, humeral cut guide member 602 isflexible so as to be able to bend into position on humeral bone 26 withsurgeon assistance through use of protrusions 620A and 620B.

In the example of humeral cut guide member 602, distal end 616 includesprotrusion 620A and support 622 that further provide registration withhumeral head 26 via patient-specific surface 666. In particular, support622 extends the width of registration portion 616 to increase thepatient-specific fit with humeral bone 26. Protrusion 620A also includescurved contact surface 668 that allows registration member 614 to bemanipulated by the surgeon into correct alignment on humeral bone 26.Sidewalls 670A and 670B connect to and diverge away from the pair ofsupports 612A and 612B, respectively, and are joined by contact surface668. Registration member 614 may also include protrusion 620B thatprovides curved contact surface 672 that allows humeral cut guide member604 to be manipulated by the surgeon into correct alignment on thehumeral bone 26. The surgeon may place a finger-tip upon contact surface672 and a thumb on contact surface 668, which allows the surgeon tosqueeze registration member 614 to orient the humeral cut guide member604 and ensure that bone-engagement surfaces 660, 662, 664 and 666properly align with bone surfaces of humeral bone 26. Cut guide member602 can be made of flexible material, such as polymers, to allowregistration member 614 and bone-engagement member 604 to flex toaccommodate slight imperfections in patient-specific surfaces 660-666 ormisalignments in registration member 614 and bone-engagement member 604.Thus, a surgeon can press down on protrusions 620A and 620B to forcepatient-specific surfaces 660-666 into position, which may cause slightbending of registration member 614 and bone-engagement member 604 in theprocess.

As best illustrated in FIG. 21A, bone-engagement member 604 includes anelongated primary member 608 extending in a first direction (i.e., adirection parallel with a coronal plane of the body) over humeral bone26, including pin guide aperture 610. Pin guide aperture 610 is alignedper the specific patient and allows for passage of a drill, Steinmannpin, or guide wire (not shown), that allows humeral bone 26 to beprepared, (e.g., reamed) at the appropriate location for any desiredresurfacing of humeral bone 26. Bone-engagement member 604 also includesa pair of supports 612A and 612B and a pair of supports 613A and 613Bextending substantially orthogonal to primary member 608. Supports 612and 613 define portions of bone-engagement surface 660, and assist inmating and nesting humeral cut guide member 602 in only one position onhumeral bone 26 with or without associated soft tissues.

Humeral cut guide member 602 includes cut guide plate 624 includingelongated slot 626. Cut guide plate 624 is connected to registrationmember 614 with a tube shaped, elongate member 628 that extends outwardfrom registration member 614 such that cut guide plate 624 may be spacedapart from humeral bone 26. By spacing cut guide plate 624 away fromhumeral bone 26, the unnecessary removal of soft-tissue (e.g., muscle,cartilage, etc.) from humeral bone 26 is prevented, which assists in thepatient's recovery after the arthroplasty. Although elongate member 628extends outward from registration member 614 to an extent that cut guideplate 624 will be spaced apart from humeral head 26, it should beunderstood, however, that the location of cut guide plate 624 may beadjusted along elongate member 628 such that cut guide plate 624 may bemoved closer to humeral bone 26, if desired.

More specifically, cut guide plate 624 includes a connection portion 630at end 632 thereof that is configured to mate with elongate member 628.Further, connection portion 630 may include mating socket 634 that isdesigned to allow elongate member 628 to smoothly slide therein. In thisregard, connection portion 630 may be urged along elongate member 628 toadjust the position of cut guide plate 624 relative to humeral bone 26in an infinite number of positions. As connection portion 630 is urgedalong elongate member 628, the T-shape of elongate member 628 slideswithin the corresponding T-shape of socket 634. Connection portion 630may then be moved when a force sufficient to overcome the frictionbetween socket 634 and elongate member 628 is applied. Once the force isremoved, the frictional engagement between the T-shaped members holdscut guide plate 624 in the desired location without the aid ofprotrusions 536 and aperture 534 (FIG. 14). In this manner, the positionof cut guide plate 624 may be selectively adjusted based on thepreferences of the surgeon during the shoulder arthroplasty. Connectionportion 630 can include flange 674 that can be grasped by a surgeon tofacilitate movement of cut guide plate 624 on elongate member 628. Itshould be understood that although cut guide plate 624 has beendescribed above as being movable along elongate member 628, the presentdisclosure contemplates configurations where cut guide plate 624 isimmovably fixed to elongate member 628.

As best shown in FIG. 21A, cut guide plate 624 includes upper member 638spaced apart from lower member 640, with elongated slot 626 defined bygap 642 between upper member 638 and lower member 640. Lower member 640defines elongated apertures 644A and 644B that are configured to receivea drill (not shown) for drilling humeral bone 26. After drilling of thehumeral bone 26, a pin (not shown) such as a Steinmann pin or K-wire maybe implanted in humeral bone 26, which may be used to assist inpositioning humeral cut guide member 602 relative to humeral bone 26. Inthe illustrated embodiment, elongated apertures 644A and 644B travelparallel to elongate member 628 to allow cut guide plate 624 to movealong elongate member 628 without interference from the pin (not shown).If cut guide plate 624 is immovably fixed to elongate member 628,however, it will be appreciated that elongated apertures 644A and 644Bmay extend in a non-parallel manner relative to elongate member 628 toassist in securing cut guide member 602 to humeral bone 26. Although apair of elongated apertures 644A and 644B are illustrated in thefigures, it should be understood that more or fewer elongated aperturemay be used.

Although not required, lower member 640 may define a surface, such assurface 546 of FIG. 14, that extends outward relative to upper member638 such that a shelf or platform is formed. The platform allows for agreater amount of surface area for the tool blade (not shown) to lieupon during resurfacing or resecting of humeral bone 26. In this manner,the tool blade is substantially prevented from being improperly angledduring the resurfacing or resecting of humeral bone 26 to form a planarsurface.

As shown in FIG. 21A, support bar 650 may fix upper member 638 to lowermember 640. Support bar 650 is formed at an opposite end 652 of cutguide plate 624 relative to end 632 of elongate member 628. Support bar650 assists in maintaining the proper gap 642 between upper member 638and lower member 640. Notwithstanding, it should be understood thatsupport bar 650 is removable during surgery by cutting support bar 650with the saw or blade for resecting or resurfacing humeral bone 26, asdesired by the surgeon. It should be understood that although elongatemember 628 is illustrated as fixing cut guide plate 624 in an infinitenumber of positions relative to humeral head 26, tube-shaped member 628may be adjustable as illustrated in FIGS. 14-19 into a plurality ofdiscrete positions.

The foregoing description of the embodiments has been provided forpurposes of illustration and description. It is not intended to beexhaustive or to limit the disclosure. Individual elements or featuresof a particular embodiment are generally not limited to that particularembodiment, but, where applicable, are interchangeable and can be usedin a selected embodiment, even if not specifically shown or described.The same may also be varied in many ways. Such variations are not to beregarded as a departure from the disclosure, and all such modificationsare intended to be included within the scope of the disclosure.

Various Notes & Examples

Example 1 can include or use subject matter such as a humeral cut guidesystem for a humeral head, the humeral cut guide system comprising: abone-engagement member including a first patient-specificbone-engagement surface that is complementary and made to substantiallymate and nest in only one position on a specific patient's humeral head;a registration member connected to the bone-engagement member includinga second patient-specific bone engagement surface that is sized and madeto substantially mate and nest in only one position with the specificpatient's bicipital groove; a first protrusion extending from theregistration member and having a first surgeon-engaging surface formanipulation by a surgeon; and a cut guide plate connected to andextending away from the registration member such that, upon thebone-engagement member mating and nesting with the specific patient'shumeral head, the cut guide plate is spaced apart from the humeral head,wherein the cut guide plate defines an elongate slot.

In Example 2, the subject matter of Example 1 can optionally include asecond protrusion extending from a junction between the bone-engagementmember and the registration member.

In Example 3, the subject matter of Example 2 can optionally include asecond protrusion including: a pair of supports extending fromrespective sides of the registration portion; a pair of sidewallsconnected to and diverging away from the pair of supports; and a secondsurgeon-engaging surface connecting the pair of sidewalls to each other.

In Example 4, the subject matter of any one or more of Examples 2-3 canoptionally include a registration member that is flexible between thefirst and second protrusions.

In Example 5, the subject matter of Example 4 can optionally include abone-engagement member and a registration member that are comprised of apolymer material.

In Example 6, the subject matter of any one or more of Examples 4-5 canoptionally include a registration member including a first portion and asecond portion, the first portion having the second patient-specificbone engagement surface and the second portion having a thirdpatient-specific bone engagement surface that is sized and made tosubstantially mate and nest in only one position with the specificpatient.

In Example 7, the subject matter of any one or more of Examples 1-6 canoptionally include a first protrusion including a registration flangeextending from a juncture of the registration member and the firstprotrusion.

In Example 8, the subject matter of Example 7 can optionally include aregistration flange comprising a curved body having an inner surface forcontacting bone and an outer surface for engaging a thumb of a surgeon.

In Example 9, the subject matter of Example 8 can optionally include aninner surface that is shaped to mate on a lateral surface of a humeralbone opposite a humeral head.

In Example 10, the subject matter of any one or more of Examples 8-9 canoptionally include an inner surface that is patient-specific and anouter surface that includes a concave contour.

In Example 11, the subject matter of any one or more of Examples 1-10can optionally include: an elongate member extending from theregistration member; and a connection portion connected to the cut guideplate; wherein the elongate member is configured to smoothly slide alongthe connection portion.

In Example 12, the subject matter of Example 11 can optionally includean elongate member that is infinitely positionable along the connectionportion.

In Example 13, the subject matter of any one or more of Examples 11-12cab optionally include an elongate member that has a T-shape and aconnection portion that has a corresponding T-shaped socket.

Example 14 can include or use subject matter such as a humeral cut guidesystem for a humeral head, comprising: a bone-engagement memberincluding a first patient-specific bone-engagement surface that iscomplementary and made to substantially mate and nest in only oneposition on a specific patient's humeral head; a registration memberconnected to the bone-engagement member including a secondpatient-specific bone engagement surface that is sized and made tosubstantially mate and nest in only one position with the specificpatient's bicipital groove; an elongate member extending from theregistration member; and a cut guide plate having a connection portionwith a socket configured to receive the elongate member such that aposition of the cut guide plate relative to the specific patient'shumeral head is selectively adjustable along the elongate member in aninfinite number of positions.

In Example 15, the subject matter of Example 14 can optionally includean elongate member that is configured to smoothly slide along the socketof the connection portion.

In Example 16, the subject matter of any one or more of Examples 14-15can optionally include an elongate member that has a T-shape and a slotof the connection portion that has a corresponding T-shaped socket.

Example 17 can include or use subject matter such as a method ofresecting or resurfacing a humeral head using a humeral cut guide, themethod comprising: positioning a bone-engagement member along a humeralhead surface of a humeral bone; positioning a registration member alonga bicipital groove surface of a humeral bone; squeezing the registrationmember and the bone-engagement member to ensure seating of the humeralcut guide; sliding a cut guide plate along an elongate member extendingfrom the humeral cut guide to engage the humeral head surface of thehumeral bone; and resecting or resurfacing the humeral head using acutting device engaged with the cut guide plate.

In Example 18, the subject matter of Example 17 can optionally includemanipulating the humeral cut guide using a pair of protrusions extendingfrom opposite ends of the registration member.

In Example 19, the subject matter of Example 18 can optionally include abone-engagement member and a registration member that include first andsecond patient-specific surfaces, respectively.

In Example 20, the subject matter of any one or more of Examples 17-19can optionally include smoothly sliding the cut guide plate along theelongate member through an infinitely small number of positions to reacha resecting or resurfacing position.

Each of these non-limiting examples can stand on its own, or can becombined in various permutations or combinations with one or more of theother examples.

The above detailed description includes references to the accompanyingdrawings, which form a part of the detailed description. The drawingsshow, by way of illustration, specific embodiments in which theinvention can be practiced. These embodiments are also referred toherein as “examples.” Such examples can include elements in addition tothose shown or described. However, the present inventors alsocontemplate examples in which only those elements shown or described areprovided. Moreover, the present inventors also contemplate examplesusing any combination or permutation of those elements shown ordescribed (or one or more aspects thereof), either with respect to aparticular example (or one or more aspects thereof), or with respect toother examples (or one or more aspects thereof) shown or describedherein.

In the event of inconsistent usages between this document and anydocuments so incorporated by reference, the usage in this documentcontrols.

In this document, the terms “a” or “an” are used, as is common in patentdocuments, to include one or more than one, independent of any otherinstances or usages of “at least one” or “one or more.” In thisdocument, the term “or” is used to refer to a nonexclusive or, such that“A or B” includes “A but not B,” “B but not A,” and “A and B,” unlessotherwise indicated. In this document, the terms “including” and “inwhich” are used as the plain-English equivalents of the respective terms“comprising” and “wherein.” Also, in the following claims, the terms“including” and “comprising” are open-ended, that is, a system, device,article, composition, formulation, or process that includes elements inaddition to those listed after such a term in a claim are still deemedto fall within the scope of that claim. Moreover, in the followingclaims, the terms “first,” “second,” and “third,” etc. are used merelyas labels, and are not intended to impose numerical requirements ontheir objects.

Method examples described herein can be machine or computer-implementedat least in part. Some examples can include a computer-readable mediumor machine-readable medium encoded with instructions operable toconfigure an electronic device to perform methods as described in theabove examples. An implementation of such methods can include code, suchas microcode, assembly language code, a higher-level language code, orthe like. Such code can include computer readable instructions forperforming various methods. The code may form portions of computerprogram products. Further, in an example, the code can be tangiblystored on one or more volatile, non-transitory, or non-volatile tangiblecomputer-readable media, such as during execution or at other times.Examples of these tangible computer-readable media can include, but arenot limited to, hard disks, removable magnetic disks, removable opticaldisks (e.g., compact disks and digital video disks), magnetic cassettes,memory cards or sticks, random access memories (RAMs), read onlymemories (ROMs), and the like.

The above description is intended to be illustrative, and notrestrictive. For example, the above-described examples (or one or moreaspects thereof) may be used in combination with each other. Otherembodiments can be used, such as by one of ordinary skill in the artupon reviewing the above description. The Abstract is provided to complywith 37 C.F.R. §1.72(b), to allow the reader to quickly ascertain thenature of the technical disclosure. It is submitted with theunderstanding that it will not be used to interpret or limit the scopeor meaning of the claims. Also, in the above Detailed Description,various features may be grouped together to streamline the disclosure.This should not be interpreted as intending that an unclaimed disclosedfeature is essential to any claim. Rather, inventive subject matter maylie in less than all features of a particular disclosed embodiment.Thus, the following claims are hereby incorporated into the DetailedDescription as examples or embodiments, with each claim standing on itsown as a separate embodiment, and it is contemplated that suchembodiments can be combined with each other in various combinations orpermutations. The scope of the invention should be determined withreference to the appended claims, along with the full scope ofequivalents to which such claims are entitled.

The claimed invention is:
 1. A humeral cut guide system for a humeralhead, the humeral cut guide system comprising: a bone-engagement memberincluding a first patient-specific bone-engagement surface that iscomplementary and made to substantially mate and nest in only oneposition on a specific patient's humeral head; a registration memberconnected to the bone-engagement member including a secondpatient-specific bone engagement surface that is sized and made tosubstantially mate and nest in only one position with the specificpatient's bicipital groove; a first protrusion extending from theregistration member and having a first surgeon-engaging surface formanipulation by a surgeon; and a cut guide plate connected to andextending away from the registration member such that, upon thebone-engagement member mating and nesting with the specific patient'shumeral head, the cut guide plate is spaced apart from the humeral head,wherein the cut guide plate defines an elongate slot.
 2. The humeral cutguide system of claim 1, further comprising a second protrusionextending from a junction between the bone-engagement member and theregistration member.
 3. The humeral cut guide system of claim 2, whereinthe second protrusion includes: a pair of supports extending fromrespective sides of the registration portion; a pair of sidewallsconnected to and diverging away from the pair of supports; and a secondsurgeon-engaging surface connecting the pair of sidewalls to each other.4. The humeral cut guide system of claim 2, wherein the registrationmember is flexible between the first and second protrusions.
 5. Thehumeral cut guide system of claim 4, wherein the bone-engagement memberand the registration member are comprised of a polymer material.
 6. Thehumeral cut guide system of claim 4, wherein the registration memberincludes a first portion and a second portion, the first portion havingthe second patient-specific bone engagement surface and the secondportion having a third patient-specific bone engagement surface that issized and made to substantially mate and nest in only one position withthe specific patient.
 7. The humeral cut guide system of claim 1,wherein the first protrusion includes a registration flange extendingfrom a juncture of the registration member and the first protrusion. 8.The humeral cut guide system of claim 7, wherein the registration flangecomprises a curved body having an inner surface for contacting bone andan outer surface for engaging a thumb of a surgeon.
 9. The humeral cutguide system of claim 8, wherein the inner surface is shaped to mate ona lateral surface of a humeral bone opposite a humeral head.
 10. Thehumeral cut guide system of claim 8, wherein the inner surface ispatient-specific and the outer surface includes a concave contour. 11.The humeral cut guide system of claim 1, further comprising: an elongatemember extending from the registration member; and a connection portionconnected to the cut guide plate; wherein the elongate member isconfigured to smoothly slide along the connection portion.
 12. Thehumeral cut guide system of claim 11, wherein the elongate member isinfinitely positionable along the connection portion.
 13. The humeralcut guide system of claim 11, wherein the elongate member has a T-shapeand the connection portion has a corresponding T-shaped socket.
 14. Ahumeral cut guide system for a humeral head, comprising: abone-engagement member including a first patient-specificbone-engagement surface that is complementary and made to substantiallymate and nest in only one position on a specific patient's humeral head;a registration member connected to the bone-engagement member includinga second patient-specific bone engagement surface that is sized and madeto substantially mate and nest in only one position with the specificpatient's bicipital groove; an elongate member extending from theregistration member; and a cut guide plate having a connection portionwith a socket configured to receive the elongate member such that aposition of the cut guide plate relative to the specific patient'shumeral head is selectively adjustable along the elongate member in aninfinite number of positions.
 15. The humeral cut guide system of claim14, wherein the elongate member is configured to smoothly slide alongthe socket of the connection portion.
 16. The humeral cut guide systemof claim 14, wherein the elongate member has a T-shape and the slot ofthe connection portion has a corresponding T-shaped socket.
 17. A methodof resecting or resurfacing a humeral head using a humeral cut guide,the method comprising: positioning a bone-engagement member along ahumeral head surface of a humeral bone; positioning a registrationmember along a bicipital groove surface of a humeral bone; squeezing theregistration member and the bone-engagement member to ensure seating ofthe humeral cut guide; sliding a cut guide plate along an elongatemember extending from the humeral cut guide to engage the humeral headsurface of the humeral bone; and resecting or resurfacing the humeralhead using a cutting device engaged with the cut guide plate.
 18. Themethod of claim 17, further comprising manipulating the humeral cutguide using a pair of protrusions extending from opposite ends of theregistration member.
 19. The method of claim 18, wherein thebone-engagement member and the registration member include first andsecond patient-specific surfaces, respectively.
 20. The method of claim17, further comprising smoothly sliding the cut guide plate along theelongate member through an infinitely small number of positions to reacha resecting or resurfacing position.